Citation

Tyree GA, Vaida F, Zisook S, Mathews WC, Grelotti DJ. J. Affect. Disord. 2019; 258: 163-171.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.jad.2019.07.081

PMID

31426014

Abstract

BACKGROUND: Chronicity of depression among people living with HIV (PLWH) is associated with poorer viral suppression and mortality risk. The extent to which suicidal ideation (SI) and other baseline characteristics predict a prolonged duration of depressive illness among PLWH is not known but could help identify PLWH most at risk.

METHODS: Data were drawn from a sample of 1002 depressed PLWH engaged in primary care at a metropolitan HIV clinic from 2007-2018, representing 2,569 person-years. Depression characteristics were derived from the Patient Health Questionnaire 9 (PHQ-9), administered during routine screening. Other characteristics were derived from clinic data. Unadjusted and covariate-adjusted survival analyses compared the time to depression remission between depressed participants with and without SI at their initial screening.

RESULTS: At baseline, 38.4% of depressed PLWH endorsed SI. Depressed PLWH with SI took significantly longer to achieve remission from depression than those without SI. The association appeared to be mediated by depression symptom severity. When adjusted for age, depression diagnosis, any recent drug use, and depression symptom severity, baseline SI no longer predicted remission hazard. LIMITATIONS: Participants were assessed for depression with variable frequency. The analysis assumed all patients received comparable treatment for their depression. Some variables were based on clinic measurements that may be subject to misclassification bias.

CONCLUSIONS: These data suggest that depressed PLWH with SI are at risk for greater chronicity of depression because their depression is more severe. Accordingly, PLWH should be urgently engaged in psychiatric care in the event of SI or severe depressive symptoms.

Keywords: Suicide misclassification

Language: en

Keywords

Adult; Humans; Female; Male; Middle Aged; Time Factors; *suicide; *Suicidal Ideation; *AIDS; *Chronobiology Phenomena; *HIV; *major depressive disorder; *suicidality; Chronic Disease; Depressive Disorder/*psychology/virology; HIV Infections/*psychology; Patient Health Questionnaire; Primary Health Care; Severity of Illness Index